;

REPUtIL!l( llrJ DCIN [.S l;1

REPUALIC OF INDO LSIA
PASPOR
PASSPORI
IDN B?87$156
ZAINAL ABIDIN

INDONESIA

22 MAY t99t t/M MAROS

07 AUG 2017 a7 AUG 20?2

NrKrM1.tOt29s{4558 1A13F82619CRPX MAKASSAR

87 E7 6156<7 7DNg105229n??08073730904?20 5 oOO2 52

 GOVERNMENT OF PAKISTAN
VISA APPUCATON FORM

(Please read these instructions carcfully before filling in the application fom)
1. No column should be left blank. Incomplete forms with vague entries shall not be
accepted. Where applicable copies of supporlive documents should be submitted
along with the application form.
2. Applicants may use extra sheets, in case of insufficient space in the columns of the
visa form.
Two (02) passport size photographs should be attached with the visa form.
4. Normal processing time for visa is 4-6 weeks.
5. Applicants could be asked to appear for interview if required.
b. On anival, immigration formalities are mandatory. (Police registration is applicable in
certain cases).
7. Attach blank statement for business visit.
8. Applicant's family" includes spouse, son, daughter, father, mother,.

PART. I

1. Type of visa aoplied for:

Diplomatic I officiat E tv]ititary n n Tourist E

Business
Family E Transit E Journalist f] Othersg (speciS-
2. Purpose of Visit:
TABLIGH VISA

3. Duration of Stay: 45 DAys

4. Visa required for: Less than 01 l\4onth E 06 Months ! Ot Vear I OZ Years E 05 years E
5. Tvpe of Visa: Single!l Doubte Entry !
Entry Muttipte Entry !

Port of Entry LAHoRE ii. Port of DepartureJAKABIA

Places to be visited in Pakistan:

a.laHQBE b. .C d.

6 SECTION I (APPLICANT'S DETAILS}

I Name as in Passport: ZAINAL

First M ddle Last

ii. Date of Birth:
22 /95 191

dd/mm/yy

iii. Place of Birth: City: MAROS Country: INDONESIA

iv. Sex: Male fl Female tl V.Blood Group:

 vi. MaritalStatus: Single Z l\ilarried tr
viii. Native Language: tNDoNES|A

Nationality: (a) Present INDONESIA (b) Previous (c) Dual

Religion: MoSLEM

PASSPORT DETAILS:

!
Type of passport:: Diplomatic Official i Service ! OrOinary [
UN Travel Documents tr

Passport Number: 87876156 place of lssue: MAKASSAR

o7108/2022
Date of lssue: 07lOAl2O17 Date of Expiry:

lssuing Authority: IMMIGRATION OF MAKASSAR

ADDRESS & EMAIL:

a. Abroad / Country of Origin. JL. TAQWA DESA BAJU BANDAN

KAB. MAROS - SULAWESI SELATAN

Telephone: (i) Home : (ii)Work: (lll) Csll

+62812 4341 1877

b. ln Pakistan. MADRASSaH aRABla RAIwlND - LAHoRE

Telephone; (i) Home : (ii) Work: (lll) Cell

Email:

ls your visit sponsored? Yes tr Z

lf yes, give details.

/Vame of Sponsor Iddress Contect numbet

Home:
Work:
Cell:

xtv. DETAILS OF PROFESSION

a. Profession (Please specify Rank / Service, in case of Armed Forces / Uniform Personnel):

BUSINESS

Xglgi ln case of military services, Please fill in the atrached Performa.

b. Employer's / Sponsor's details ( in Pakistan / Abroad (if Applicable)

Telephone No. Email

Name Address
Home Office Cellular Address
xv, DETAILS OF JOBS HELD IN THE PAST:

a. Designationl b. Department:

c. Duration (ftom - to) d. Duties:

e. Address & Phone No.

f: Name, address and contract numbers of immediate boss/head and any other colleague:

(use extra sheet if required)

xvr. Are you applying visa from a third country? Yes tr No Z

lf yes, please provide copy of residence / work permit of that country.

7. SECTION II ( FAMILY DETAILS}

i, Name of [4other HASUN I Nationality of l\4other tNpoNESlA

iii. |11smg 61Ps1661. MASSE Nationality of Father tNDoNEStA

Spouse details:

Name Nationality

Date and place of birth

Profession

Name, Address and contact number of employer of spouse (if any)

vi. Do you have any children? YestrNoZ

lf yes, please provide details for each of your child.

Name Date of Birth

vii. Please list any of accompanying person i family member (including children) traveling with you to

Pakistan.

Full Name, Date of Bitth, Passport Number (if any) Address

Do you have any bank account in Pakistan? Yes tr No Z

Bank Name Branch AlC Number Address Verifiet details
I TMVEL HISTORY:
I Have you ever visited Pakistan during last five years? Yes tr No g if yes, please

Provide details.

Date Desfination / Address Purpos e Dwation

1.
)
3.
4.
5.

Details ofother countries visited, during last two years,

Date Destination / Address Purpos e Duration

1.
)
3.
4.
5.

t. Have you ever been refused a visa for any country, including Pakistan? Yes ENo U
iv Have you ever been refused entry on arrival to Pakistan? Yes lNo Z
lf yes, please provide details of refusal.

Have you ever been deported, removed or otherwise required lo leave any country, including Pakistan?

Yes n No A Ifyes, please provide details.

Date Country Reason Reference Number (for Pakistan)

Do you have any criminal convictions or charged in any country? Yes tr No Z

Date Country Offence Sentence

DECLAMTION: I declare that the information given in this form is correct to the best of my knowledge

and belief and if any of the particulars furnished above are found to be incorrect or
withheld the visa is liable to be rejected i cancelled at any time

Dated:

(Signature of Applicant)
 PART- II

PROCESSING CERTIFIGATION

1. Date of receipt of Visa Application:

2. Registration Number:

J. Visa fee received:

4. Additional Documents received:

a. b.

d.
( Particulars of ofiicial who checked the visa form for its conectness and supporting documents.

a. Name b. Designation
b. Date c. Signature_
Details of clearance received from Ministry of lnterior.

Dated

7. Decision by officer in-charge.

a. Accepted tr b. Regretted

c. Type of Visa issued.

d. Duration

e. Single Entry f. Multiple Entry

Dated:

(Signature of Visa lssuing Authority)